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. 2018:22:17-173.
doi: 10.7812/TPP/17-173.

ECG Diagnosis: Accelerated Idioventricular Rhythm

Thomas H Gildea  1 , Joel T Levis  2
Affiliations

ECG Diagnosis: Accelerated Idioventricular Rhythm

Thomas H Gildea et al. Perm J. 2018.
No abstract available

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Conflict of interest statement

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
12-lead electrocardiogram from a 61-year-old man presenting to the Emergency Department with 2 hours of chest pain, demonstrating sinus bradycardia, heart rate of 47 beats/min, minimal (< 1 mm) ST-segment elevation in leads I and aVL, and reciprocal ST-segment depressions in leads III and aVF, which are characteristics consistent with an evolving high lateral-wall myocardial infarction. The electrocardiogram does not meet ST-segment elevation myocardial infarction criteria of ≥ 1 mm ST-segment elevation in 2 or more contiguous leads.
Figure 2
Figure 2
Repeat 12-lead electrocardiogram from the same patient as in Figure 1, obtained 1 hour after the initial electrocardiogram (after treatment with aspirin and sublingual nitroglycerin, with improvement in chest pain), demonstrating a wide-complex, regular, accelerated junctional rhythm, heart rate of 63 beats/min, which is consistent with an accelerated idioventricular rhythm. In the setting of evolving lateral wall ST-segment elevation myocardial infarction, this finding is suggestive of spontaneous reperfusion of an occluded coronary artery.
Figure 3
Figure 3
Repeat 12-lead electrocardiogram from the same patient, obtained 1 minute after the electrocardiogram in Figure 2, demonstrating conversion from accelerated idioventricular rhythm back into sinus bradycardia. Subsequent coronary angiography demonstrated 99% stenosis of the first diagonal branch of the left anterior descending coronary artery, which was successfully treated with percutaneous coronary intervention and stenting.
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